Patient Comorbidities Drive 90-Day Emergency Department Revisits and Readmissions After Trimalleolar Ankle Fracture Open Reduction and Internal Fixation: A National Database Analysis.

Abstract

Trimalleolar ankle fractures are associated with high complication rates and unplanned healthcare utilization. This study aimed to (1) characterize the demographic and clinical profile of patients requiring 90-day readmission; (2) identify risk factors for 90-day emergency department (ED) utilization; and (3) determine comorbidities most strongly linked to 90-day readmissions following trimalleolar open reduction and internal fixation (ORIF). Using the PearlDiver Mariner database from 2010 to 2021, patients undergoing trimalleolar ankle fracture ORIF were identified through current procedural terminology codes 27822 and 27823. Ninety-day postoperative ED visits and hospital readmissions were evaluated. Patients with ED utilization (N = 636) were compared with controls without ED visits (N = 79,956). Logistic regression was used to identify demographic and comorbidity risk factors for both ED utilization and readmission, with statistical significance set at P < 0.05. ED utilization was higher among older patients (peak 70 to 74 years, P < 0.001). Comorbidities markedly associated with 90-day ED revisits included congestive heart failure (CHF) [odds ratio (OR) 1.55, P = 0.001], fluid and electrolyte disorders (OR 1.35, P = 0.001), pathologic weight loss (OR 1.34, P = 0.012), hypertension (OR 1.26, P = 0.043), and peripheral vascular disease (PVD) (OR 1.25, P = 0.038). Risk factors for 90-day readmission included fluid and electrolyte disorders (OR 1.98, P < 0.001), coagulopathy (OR 1.44, P < 0.001), CHF (OR 1.35, P < 0.001), PVD (OR 1.33, P < 0.001), and pathologic weight loss (OR 1.44, P < 0.001). Postoperative ED visits and readmissions following trimalleolar ORIF are driven largely by patient comorbidities. Older, medically complex patients represent a high-risk group, and targeted perioperative optimization may reduce complications and unplanned healthcare utilization.